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I have had a hemorrhoid for at least 10 years.

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Gastroenterologist
Practicing since : 1986
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I have had a hemorrhoid for at least 10 years. It does not itch nor does it hurt. I have trouble getting everything out because it snakes out. When it is lower down it keeps my anus open and I don't feel it when I use the bathroom. What can I do?
Posted Tue, 28 Nov 2017 in Digestion and Bowels
 
 
Answered by Dr. Ramesh Kumar 44 minutes later
Brief Answer:
Most likely its internal hemorhoid.Proper management should be done.

Detailed Answer:

Hello,
Thanks for query.
Initially as your case is grade 1 hemorrhoid conservative mangenent is adviced.

Syp. Lactulose 10-15ml once daily before going to bed. It is one of the most frequently used laxatives, tolerated very well by patients in long terms with minimal side effects. Using laxative would prevent straining while defecating.It would loosen up your stools hence they would pass easily.

-Secondly, start using Prepration H (a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc.) locally over the prolapsed hemorrhoids.Its over the counter.

Thirdly, get a prescription for oral Calcium Dobesilate for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.It was demonstrated that calcium dobesilate decreased capillary permeability, inhibited platelet aggregation and improved blood viscosity; thus resulting in reduction of tissue edema.

Add Metamucil/Fybrogel to your regimen. It's a natural laxative containing husk. It absorbs water from the intestine and swells up making passage of stool easy and add bulk to stool.Take it 2 tsf twice daily with half cup of XXXXXXX warm milk.

If not relieved in 3 months then minimally invasive procedures could be done like-

1)Sclerotherapy: This is currently recommended as a treatment option for first- and second-degree hemorrhoids. The rationale of injecting chemical agents is to create a fixation of mucosa to the underlying muscle by fibrosis.

2)Rubber band ligation: Rubber band ligation (RBL) is a simple, quick, and effective means of treating first- and second-degree hemorrhoids.
3)Cryotherapy: Cryotherapy ablates the hemorrhoidal tissue with a freezing cryoprobe. It has been claimed to cause less pain because sensory nerve endings are destroyed at very low temperature.

In case if this is not successful then we have invasive surgical procedures like-

1)Hemorrhoidectomy: Excisional hemorrhoidectomy is the most effective treatment for hemorrhoids with the lowest rate of recurrence compared to other modalities.Success rate is more then 90%.

2)Stapled hemorrhoidopexy-A circular stapling device is used to excise a ring of redundant rectal mucosa proximal to hemorrhoids and resuspend the hemorrhoids back within the anal canal. Apart from lifting the prolapsing hemorrhoids, blood supply to hemorrhoidal tissue is also interrupted.


Have provided you with all possible approaches.
Please discuss them with your primary.

Thanks!

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